Tuesday, July 30, 2019

Ohio’s State Budget & Community Health Centers


Ohio’s State Budget & Community Health Centers: 

A Policy Wonk’s Perspective


House Bill 166, the state biennial operating budget, was enacted into law officially on July 18 with Governor DeWine’s signature and his subsequent vetoes. Overall, health center advocates are pleased with the progress made (and/or maintained) in HB 166, and we thank each and every advocate that contributed along the way!  Your advocacy matters, and truly made a difference. See a bulleted list of our priorities below:

Medicaid Expansion remains intact!
FQHC Primary Care Workforce Initiative (OPCWI) was fully restored (and slightly increased)!
Names FQHCs to the Health Care Workforce Preparation Task Force - The Ohio Physician and Allied Health Care Workforce Preparation Task Force is created to study, evaluate, and make recommendations with respect to health care workforce needs in Ohio. FQHC representation is specifically noted in the Task Force composition
Pharmacy/PBM Items: 
  • Dispensing Fees – Requires ODM to adopt rules to provide to pharmacies a supplemental dispensing fee under the care management system. Provides that the dispensing fee must include at least three different payment levels 
  • Single PBM- Requires the Medicaid Director, not later than July 1, 2020, to select a provisional single state pharmacy benefit manager (PBM) to administer pharmacy benefits for Medicaid managed care organizations (MCOs) 
    • Requires the Director to collect from the state PBM clinical data
    • Requires a PBM under contract with a Medicaid MCO to administer pharmacy services under the care management system to: (1) Upon the request of ODM, disclose all of its received payment streams, including drug rebates, discounts, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other payments
  • Prescribed Drugs - Permits, instead of requiring, ODM to include prescribed drugs in the Medicaid managed care system
  • Prescribed Drug Spending - Requires the Medicaid Director, not later than July 1, 2020, to establish an annual benchmark for prescribed drug spending growth under the Medicaid Program
  • Establishes an appeals process for prescription drugs maximum allowable cost- Requires the Medicaid Director to establish an appeals process that pharmacies can use to bring to the Department of Medicaid disputes about the maximum allowable cost set by the state PBM for a prescription drug
  • Prescribed Drug Claims Processing Pilot Program- Requires ODM by Jan 1, 2020, to establish a Southeast Ohio pilot program for pre-audit processing of Medicaid MCOs and pharmacy benefit manager prescribed drug claims 
Telehealth - Effective Jan.1, 2021, requires all commercial health benefit plans to provide coverage for telemedicine services on the same basis and to the same extent as in-person services. Prohibits such plans from excluding telemedicine services from coverage solely because they are telemedicine services but does not ensure payment parity. Note, expanded telehealth rules on Medicaid effective date of July 4

Infant Vitality –includes funding under the Department of Health and Medicaid for home visiting and infant vitality interventions and for Produce Perks Midwest. Additional funding for birth spacing was unfortunately removed
Improves Access to the Breast and Cervical Cancer Project (BCCP): increases eligibility to 300% of the FPL, eliminates the requirement that women be younger than 65, and lowers the age from 25 to 21 at which women with a family history or clinical exam results are eligible for screening and services
School Wellness and Success Funding – Increases the amounts to $275M in FY20 and $400M in FY21 and expands permissible uses of student wellness and success funds (FQHCs are eligible partners; funding can also be used for capital expenses)
SDOH – Requires the Medicaid Director to implement strategies that address social determinants of health and employment
CPC/CPC for Kids – Funding intact 
Managed Care

  • Medicaid Prompt Pay – Requires Medicaid MCOs to submit claims in accordance with requirements established by the Department of Insurance (i.e. mirroring commercial prompt pay law) 
  • Medicaid managed care performance - Requires that ODM's website include the metrics ODM uses to determine a Medicaid managed care organization's contract performance. 
    • Requires ODM, in addition to the MCO performance payment program to establish performance metrics, which may include financial incentives and penalties, to evaluate and compare Medicaid MCO contract performance and then post the metrics to the website
    • Requires ODM to update its website quarterly to reflect any changes to the metrics used

MyCare Ohio / Standardized Claims Forms -  

  • Requires the Director to (1) select a standardized claim form for each provider type from among universally accepted claim forms used in the US and (2) require that a provider that renders a medically necessary health care service under MyCare Ohio use the form
  • Requires the Medicaid Director to create standardized claim codes that allow a provider that renders a medically necessary health care service under MyCare Ohio to use the same code for that service, regardless of the payor


From the OACHC Policy Team, THANK YOU again for all you have done and continue to do!

Wednesday, July 24, 2019

Space Oddity

This year on July 20th, we celebrated the 50th anniversary of the moon landing. In 1969, 2 young astronauts did something no one had done before. They took "one small step for man" and "giant leap(s)" for mankind. Neil Armstrong and Buzz Aldrin are not only held in high regard to the space program and America, but Neil is one of the many astronauts from Ohio!

Neil Armstrong was born in Wapakoneta, Ohio in August of 1930 and was later a professor at the University of Cincinnati. Along with him, John Glenn, Judith Resnik, and Jim Lovell all hail from Ohio as well. Each one of these individuals had a significant impact on the space program and continue to be remembered for their accomplishments now. Ohio is one of the top states in the US to produce astronauts to the NASA program and to ultimately take flights. 

So what does this all mean? With more school programs being geared towards science, schools specifically meant for STEM (Science, Technology, Engineering, and Mathematics) and even toys having a space theme, its showing kids that being a "rocket scientist" may not be such a far grasp after all. Back-to-school is only a few weeks away and with all of the upcoming back to school events, its time to inspire kids to take their dreams to a galaxy far far away! 

Links to help send you into orbit:



Wednesday, July 17, 2019

Eye See You!




Your eyes are a very important part of your body and taking care of them should be a priority. Have a comprehensive dilated eye exam is one way that you can take care of your vision health. According to the National Eye Institute, many eye disorders do not have outward symptoms and one must have an eye exam to diagnose these.

Staying up to date on your family's eye health history is important in order to know if you are prone to develop issues in the future. However, there are many actions you can take to keep your eyes healthy all year long! A few things you can do are:

  • living a healthy lifestyle
  • wearing protective eyewear
  • quit smoking
  • keeping your eyes/eyelids clean
  • giving your eyes a rest (put your phone down once in a while!)
Did you know that the average American looks at screens as much as 12 hours a day! Just like any other muscle in your body, putting that much wear and tear on a body part is going to cause some side effects. For more information on how to keep your eyes healthy, visit: Eye Health Tips

Wednesday, July 3, 2019

Just Keep Swimming, Just Keep Swimming!

Literally, keep swimming! Swimming is a great exercise for people of all ages and can provide amazing health benefits to those who are looking for a low impact workout. There are lots of reasons swimming can be beneficial to your health. 

It can:

  • Improve cardiovascular health
  • Build lean muscle
  • Gives your body a break from higher-impact activities
  • Increase your endurance
  • Promotes adventure

Swimming is also an activity that doesn’t require much other than a swimsuit and a body of water. With the weather being warmer, you can swim in or outside and in a pool or fresh water! Don’t forget to take safety precautions too! If you are a first time or long time swimmer, it's always important to be aware of your surroundings and knows when the water is too deep-cold-murky-warm-shallow or whatever! And always remember sunscreen when swimming outdoors.

Learn more about how to be safe when swimming and more health benefits: